Traditionally many people regarded a Professional as an individual who dressed appropriately within their working environment, or by simply carried out a skilled task efficiently within their chosen job sector. Although these factors do contribute towards professionalism, there are many more requirements needed to become a competent skilled Dental Care Professional (DCP). To be registered as a Dental Care professional within the UK, a professional-approved qualification with in-depth training must be obtained; along with adhering to standards put in place and to help keep DCPs safe.
The concept of professionalism is sometimes used in the negative- which emphasizes on what is missing from someone's behavior, with the most minimal ethical standards of a profession, when the person's conduct is such that it is hard to think of the person acting like a member of that profession at all. (Ozar et al, 2018).
The General Dental Council has put together 9 core principles, which all registered members of the Dental team must adhere to at all times. These guidelines are put in place to guide the DCP on delivering the best possible care safely to patients, along with working within their specific Scope of Practice. Every patient needs to feel they can trust their DCP to make the correct ethical decisions, using a tailored approach that suits their individual needs. Once a registrant has completely gained their professional qualification at dental school; it is essential that they continue their professional development constantly throughout their career. This is to ensure that they stay refreshed with their specific skilled knowledge, and remain up to date with the expectations and care standards that they are required to deliver to every patient.
This essay will discuss the ethical issues which relate to the GDC standard 1:
To Put patients' interests first whilst focusing on the topic of Mental Health Conditions and their Effects on the Oral Cavity. Principle 1.6 states that You must treat patients fairly, as individuals and without discrimination.
GDC standard 1.4.2 states You must provide patients with treatment that is in their best interests, providing appropriate oral health advice and following clinical guidelines relevant to their situations. You may need to balance their oral health needs with their desired outcomes (General Dental Council, 2013).
Therefore, it is essential that all patients including those with Mental health illnesses are treated with the best adequate care possible, from a Dental Hygienists' perspective.
How do mental health conditions affect the oral cavity?
There are a variety of dental concerns for those suffering from mental health conditions which include:
Neglect
It is well established and supported by research, that individuals that suffer from Mental Health illnesses are more likely known to avoid making visits to a Dental Care Professional; which results in a neglected oral hygiene regime. Neglected Oral hygiene maintenance and care often lead to Dental Caries and poor Periodontal health.
This was demonstrated in a study of 334,503 individuals. The oral health status of people with anxiety and depressive disorders was recorded, using 19 research papers on depression andor anxiety, and 7 on dental phobiaanxiety= 26 combined. The psychiatric subjects were linked with increased dental caries with DMFT and DMFS scores, as well as increased tooth loss. Panic disorder was linked with periodontal disease.
Anxiety
Dental phobia is a condition that many people encounter. Due to the severity of anxiety felts towards dental care, this results in them not visiting a Dental Care Professional frequently enough, which in turn has a huge impact on oral health and general systemic health (Dental health.org, 2021).
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Eating Disorders
People who suffer from eating disorders including bulimia are more at risk of developing tooth erosion, due to the acid attacks produced by the individual vomit. Calcium deficiencies are often present in those with bulimia, resulting in an increased risk of poor tooth health.
Those who are deprived of nutrients, and suffer from anorexia are more susceptible to osteoporosis; which affects the person's bones and can result in tooth loss, due to the alveolar bones in the jaw becoming compromised and weak (Olliffe, 2020).
Medication
Patients with mental health illnesses will often be taking medication that may result in oral side effects. A lot of antidepressant antipsychotic medications produce unpleasant oral side effects such as Xerostomia (dry mouth), caused by the reduction of salvia.
Brushing actions and medication continued
Bipolar and similar mental health conditions can often result in a person over-brushing their teeth and gingiva too hard; creating tooth surface loss and gingival tissue destruction. Patients with Bipolar are often treated using Lithium medication. Whilst being effective at controlling mental health conditions, lithium does come with some dental side effects. Common oral side effects of taking Lithium include Xerostomia, which stops the soft tissues and teeth from being adequately hydrated and prevents the natural cleansing mechanism from occurring in the oral cavity. Those taking Lithium are more prone to dental disease due to reduced salivary flow, including caries and periodontal disease. Individuals suffering from bipolar are also known to overbrush their teeth resulting in excessive tooth wear and abrasion (Colgate, 2021). It is essential for Dental Care Professionals to be aware of the link between Mental Health and Oral Health.
The BDSH states that there are certain aspects to consider which will have an effect on an individual's oral health; resulting in poor self-care and accessibility to the use of available health care including visiting oral health providers.
Many factors contribute to the ability to access oral health and including:
- What sort of mental illness, how severe it is, and at what point it is currently at.
- How is the patient's mood, confidence and self worth at present
- How aware is the patient of their oral health status and oral problems
- Are they aware of their lifestyle and habits which contribute to their own oral health
- What environmental aspects can have an affect on negative self and dental care
- Deprivation area that the patient resides at, which may result in limited availability of health care choices
- Language barriers and cultural beliefs and standards
- Not enough knowledge is provided on accessing the information on Oral health services
- Medication taken that affects the oral cavity ie- Dry mouth Xerostomia
- Lack of knowledge of their own oral care and health care providers including dental care practitioners
- What is the awareness and knowledge, the dental care team has on Mental health illnesses
- The dental care professionals in the local area are not able to provide sufficient dental care (BSDH, 2000).
If either oral health or mental health is compromised in an individual, It is well known that if one is poor, the other will be affected in some form. Both Dental Care Professionals and Mental health care providers will gain prosperity on gathering knowledge on the relations between both; to be able to advise those with mental health conditions to take care of their own personal oral health and regime; which includes those taking certain medications for mental health conditions, along with knowledge of the side effects possible which can directly affect their oral health (Maple dental health, 2018).
Conclusion
Mental health conditions will continue to be an issue that surrounds us daily, as more and more people are being diagnosed with such illnesses. It is important that as Dental care professionals we are trained to effectively deal with a varied amount of oral conditions, which are made worse or exist due to patients' illnesses. This is supported by the research evidence included above which discusses Psychiatric subjects were linked to increased dental caries on DMFT and DMFS scores, along with increased tooth loss and periodontal disease (Journal of affective disorders). The role of a dental care professional is not only to ensure that oral symptoms andor abnormalities are detected and treated; but equally important, it is to mention that the clinician is competently ensuring that every single patient is treated fairly with integrity and respect, despite what mental health condition they present with.
As a Dental nurse for nearly 10 years, and now as a Dental Hygiene student; I have cared for and treated many patients with a variety of mental health conditions.
It is essential not to stigmatize individuals that present with mental health issues; which has been the case for many years. It is equally important, that every patient is treated as though you wish to be treated. We have to demonstrate compassion, whilst being aware of professional limitations and ensure that the GDC`s standards are followed at all times, whether this is treating and caring for our patients in a general dental practice, hospital, or care home setting.
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